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Accumulating evidence for the role of metabolic disorders such as insulin resistance, diabetes, obesity and hypertension in increasing the risk of Alzheimer’s disease and vascular dementia, is reviewed in a new paper published this month in the Archives of Neurology.

In the same journal, compelling evidence is presented that higherpre-diagnosis total cholesterol, low-density lipoprotein cholesterol,and diabetes are associated with faster cognitive decline inpatients with incident Alzheimer’s disease.

A cohort of 156 patients with incident Alzheimer’s Disease (mean age 83 years) were followed for up to 10 years. Changes in a composite score of cognitive ability were monitored from diagnosis onwards.

“These findings indicate that controlling vascular conditions may be one way to delay the course of Alzheimer’s, which would be a major development in the treatment of this devastating disease as currently there are few treatments available to slow its progression,”

said Yaakov Stern, Ph.D., a professor at the Taub Institute for the Research on Alzheimer’s Disease and the Aging Brain and director of the Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center at Columbia University Medical Center, and senior author of the paper.

“Preventing heart disease, stroke and diabetes – or making sure these conditions are well managed in patients diagnosed with them – can potentially slow the disease progression of Alzheimer’s,” said Dr. Stern.

Diets high in fruit, vegetables, fibre and unsaturated fats, and low in sugar, salt and saturated fat are known to reduce the risk of a range of chronic conditions, such as diabetes, heart disease and stroke. This means eating more plant-based foods and less processed and animal-based foods.

Stabilising blood sugar is crucial. This may be done by eating a diet with a low glycaemic load, that is, one that includes moderate quantities of complex carbohydrates which release glucose slowly into the bloodstream. Whole grains, such as whole-wheat bread, brown rice, quinoa, millet and buckwheat are valuable for helping to ensure smooth regulation of blood sugar. In contrast, highly refined carbohydrates, such as white bread, white rice, white pasta and table sugar, create a roller-coaster of blood sugar highs and lows, which if left unchecked, can ultimately give rise to insulin resistance and eventually to diabetes. Potatoes release sugar into the bloodstream almost as fast as table sugar and thus should be eaten sparingly, unless you are lean and exercise regularly. Consuming protein with carbohydrates at every meal has also been found to help regulation of blood sugar.

Increasing the quantity of vegetables and fruit in the diet is also vital. Blood sugar levels are easier to maintain if vegetables are emphasized more than fruit, as some fruit contains a lot of sugar. A minimum of 5 portions of fruit and vegetables per day is recommended. For easy tips for increasing the amount of fruit and vegetables in your diet please click here.

Unsaturated fats found in plant oils, such as olive oil and the oils of nuts and seeds, and in oily fish, are beneficial for preventing heart disease and other vascular health conditions. For practical suggestions for ways to incorporate more healthy unsaturated fats in your diet please click here.

For information and practical tuition in how to put all these recommendations together to create fabulous food that protects you from diabetes, heart disease and Alzheimer’s Disease, please come to a Cooking for Health course, run by nutrition expert, Dr Jane Philpott.

Cinnamon comes from the inner bark of evergreen trees (Cinnamomum verum, C. zeylandicum, C. aromaticum), native to Sri Lanka and other Asian countries. The bark is peeled away from the tree and curls up into tubes, called quills, as it dries.

In addition to its use as a spice, cinnamon or its oil is used as a flavouring agent in pharmaceutical, personal health and cosmetic products.

Cinnamon is one of the oldest spices known. It was imported to Egypt from China as early as 2000 BC, where it was used as a medicinal herb, a flavouring for drinks and as an embalming agent. At one time it was considered to be even more valuable than gold. Cinnamon is also mentioned in the Bible.

Moses was commanded:

“Take thou also unto thee principal spices, of pure myrrh five hundred shekels, and of sweet cinnamon half so much, even two hundred and fifty shekels, and of sweet calamus two hundred and fifty shekels” (Exodus 30:23)

“Spikenard and saffron; calamus and cinnamon, with all trees of frankincense; myrrh and aloes, with all the chief spices” (Song of Solomon 4:14)

The Roman Emperor Nero is said to have burned a year’s supply of cinnamon at the funeral for his wife Poppaea Sabina in 65 AD, to express the depth of his loss.

As its popularity grew, cinnamon was one of the first spices to be traded regularly between Europe and the Near East.

Cinnamon has many medicinal uses. It is reported to be beneficial in the treatment of arthritis, asthma, cancer, diarrhoea, fever, heart problems, insomnia, menstrual problems, peptic ulcers, psoriasis, and spastic muscles. Some of the confirmed effects of cinnamon are as a sedative for smooth muscle, circulatory stimulant, digestive aid, antibiotic, anticonvulsant, diuretic and antiulcerative.

Some studies suggest that cinnamon may be useful for people with diabetes. In one trial, 1 to 6 grams of cinnamon taken daily for forty days reduced fasting blood glucose by 18 to 29 per cent, triglycerides by 23 to 30 per cent, LDL cholesterol by 7 to 27 per cent, and total cholesterol by 12 to 26 per cent. In contrast, there were no clear changes for the subjects who did not take cinnamon[1].

Another trial showed that a cinnamon extract had a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients with poor glycaemic control[2].

Other research has shown that a substance in cinnamon called methylhydroxychalcone acts as an insulin mimetic; it stimulated glucose uptake and glycogen synthesis to a similar level as insulin[3].

Cinnamon may thus be useful for helping to treat insulin resistance and type 2 diabetes, conditions that are becoming increasingly more common in the UK and elsewhere.

Statistics published in the Journal of Epidemiology and Community Health in February 2009 indicate that the incidence of diabetes in the UK climbed 74 per cent between 1997 and 2003. By 2005, over 4 per cent of the population were classified as having some type of diabetes. The majority of new cases are type 2 diabetes, linked to diet and growing obesity rates. A research team from Spain and Sweden analysed the results, and made it clear that the trend was not due to more screening tests or an ageing population.

Ideas for incorporating cinnamon into your diet

Add 1 tsp ground cinnamon to oat porridge at breakfast

Drizzle flaxseed oil over whole-wheat toast and then sprinkle with cinnamon and a little rice malt syrup

Many popular diets emphasize either carbohydrate, protein or fat as the best way to lose weight.

Advocates of high protein diets claim that our Paleolithic ancestors obtained the majority of their calories from meat and thus our bodies have evolved to require a high protein intake. There is much scientific controversy over the relative importance of animal and plant foods in the early hominid diet. Direct evidence in the form of food remains is meagre or, at best, equivocal. Most research relies on inference through dietary studies of other primates and archaeological evidence. Most scientists now agree that plant foods contributed much more to the early hominid diet than did the flesh of animals.

Humans have adapted to their environments wherever they have settled and the balance between meat-eating and plant-eating varies substantially between populations. Some of the leanest and healthiest societies in the world, such as in the Mediterranean and Japan, consume a diet where the majority of energy comes from carbohydrates, mainly in the form of complex carbohydrates from whole grains and vegetables. This has led some researchers to propose that a high carbohydrate diet is better for maintenance of a healthy weight than a high protein diet.

Controversy about the role of fat in the diet has raged since the 1950s, when Ancel Keys published his landmark “Seven Countries” study and highlighted that coronary heart disease is strongly related to diet. Low-fat diets have therefore been promoted by governments and health professionals for several decades.

With the prevalence of obesity increasing at an alarming rate, everyone wants to know which of these dietary approaches – high protein, high carbohydrate, low fat – is the most successful for weight loss.

The scientific research conducted to date does not help much. Some trials have shown that low-carbohydrate, high-protein diets resulted in more weight loss over the course of 3 to 6 months than conventional high-carbohydrate, low-fat diets, but other trials have not shown this effect.

A smaller group of studies that extended the follow-up to 1 year did not show that low-carbohydrate, high-protein diets were superior to high-carbohydrate, low-fat diets. In contrast, other researchers found that a very-high-carbohydrate, very-low-fat vegetarian diet was superior to a conventional high-carbohydrate, low-fat diet. Among the few studies that extended beyond 1 year, one showed that a very-low-fat vegetarian diet was superior to a conventional low-fat diet, one showed that a low-fat diet was superior to a moderate-fat diet, two showed that a moderate-fat, Mediterranean-style diet was superior to a low-fat diet, one showed that a low-carbohydrate diet was superior to a low-fat diet, and another showed no difference between high-protein and low-protein diets.

Small samples, underrepresentation of men, limited generalizability, a lack of blinded ascertainment of the outcome, a lack of data on adherence to assigned diets, and a large loss to follow-up limit the interpretation of many weight-loss trials. The novelty of the diet, media attention, and the enthusiasm of the researchers may affect the adherence of participants to any type of diet.

There have been few studies lasting more than a year that evaluate the effect on weight loss of diets with different compositions of those nutrients. In a randomized clinical trial led by researchers at the Harvard School of Public Health (HSPH) and Pennington Biomedical Research Center of the Louisiana State University System, a comparison of overweight participants assigned to four different diets over a two-year period showed that reducing calories achieved weight loss regardless of which of the three nutrients was emphasized. The study, which was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, appears in the February 26, 2009 issue of The New England Journal of Medicine.

“This is important information for physicians, dieticians and adults, who should focus weight loss approaches on reducing calorie intake,” said Frank Sacks, professor of cardiovascular disease prevention at HSPH and lead author of the study.

The trial included 811 men and women who were randomly divided into four diet groups with different target nutrient compositions:

Low-fat, average protein: 20% of calories from fat, 15% of calories from protein, 65% of calories from carbohydrate

Low-fat, high-protein: 20% fat, 25% protein, 55% carbohydrate

High-fat, average protein: 40% fat, 15% protein, 45% carbohydrate

High-fat, high-protein: 40% fat, 25% protein, 35% carbohydrate

The participants were diverse in age, sex (62% women, 38% men), geography and income. The diets followed heart-healthy principles, replacing saturated with unsaturated fat and were high in whole cereal grains, fruits and vegetables. Each participant received a diet prescription that encouraged a 750-calorie reduction per day, however none were less than 1,200 total calories per day. Participants were asked to do 90 minutes of moderate exercise each week. They recorded their daily food and drink intake in a food diary and in a web-based program that provided information on how closely they were meeting their dieting goals. Individual counselling was provided every eight weeks over two years and group sessions were held three out of four weeks during the first six months and two out of four weeks from six months to two years.

The results showed that, regardless of diet, weight loss and reduction in waist circumference were similar. Participants lost an average of 13 pounds at six months and maintained a 9-pound loss at two years. Weight loss primarily took place in the first 6 months; after 12 months, all groups began to slowly regain weight, a finding consistent with other diet studies. However, the extent of weight regain was much less, about 20%, of the average regain in previous studies. Waistlines were reduced by an average of two inches at the end of the two-year period.

Most risk factors for cardiovascular disease improved for dieters at six months and two years. HDL (“good”) cholesterol increased and LDL (“bad”) cholesterol, triglycerides, blood pressure and insulin decreased. The metabolic syndrome, a group of coronary heart disease risk factors including high blood pressure, insulin resistance and abdominal obesity, also decreased.

The main finding from the trial was that diets with varying emphases on carbohydrate, fat and protein levels all achieved clinically meaningful weight loss and maintenance of weight loss over a two-year period.

“These results show that, as long as people follow a heart-healthy, reduced-calorie diet, there is more than one nutritional approach to achieving and maintaining a healthy weight,” said Elizabeth G. Nabel, M.D., Director, NHLBI.

Another important finding was that participants who regularly attended counselling sessions lost more weight than those who didn’t. Dieters who attended two thirds of sessions over two years lost about 22 pounds of weight as compared to the average weight loss of 9 pounds.

“These findings suggest that continued contact with participants to help them achieve their goals may be more important than the macronutrient composition of their diets,” said Sacks.

Have you spent years embarking on every weight-loss diet going? Have you tried cutting out entire food groups? Have you spent a fortune on miracle foods or diet powders? Have you eaten nothing except cabbage soup for weeks? Have you driven your friends mad with your fervour over food combining? Have you become obsessive about counting calories or points? Have you spent hours jumping on and off your bathroom scales? Do you feel hungry much of the time, exhausted and beset by cravings?

You can learn how to lose weight effortlessly without feeling hungry, whilst gaining health and vitality, at a Cooking for Health course on Managing Your Weight Naturally. We explore why so many diets fail and explode many of the weight loss myths. We look at cravings – how they arise and how to overcome them – and we discuss which foods the body needs to create energy and burn fat in the most efficient way. We create a delicious meal with an array of different dishes designed to illustrate how it is possible to eat plenty without gaining weight. The vital role of exercise in maintaining a healthy weight is also emphasised.

References

Strassman, B.I. and Dunbar, R.I. (1999). Human evolution and disease: putting the Stone Age in perspective. In Stearns, S.C. ed Evolution in Health and Disease, Oxford: Oxford University Press.

Lee, R.B. The !Kung San: Men, Women and Work in a Foraging Society. Cambridge University Press, 1979

Turmeric (Curcuma longa) is a herbaceous perennial plant of the ginger family, Zingiberaceae. It is native to tropical South Asia and needs temperatures between 20°C and 30°C, and a considerable amount of rainfall to survive.

Plants are gathered annually for their rhizomes. The rhizomes are boiled for several hours and then dried in hot ovens, after which they are ground into a deep orange-yellow powder commonly used in spices and curries, for dyeing, and to impart colour to mustard condiments and butter. Its active ingredient is curcumin, which has an earthy, bitter, peppery flavour and a mustardy smell.

Turmeric has been used for at least 4000 years in Traditional Chinese and Ayurvedic medicine to treat a variety of ailments.

There are frequent media reports claiming medicinal properties of turmeric, some of which are supported by quality scientific data and some of which are not.

It is important to bear in mind that many studies have been done in test tubes and animals, and the herb may work differently or not as well in humans.

Furthermore, some studies have used an injectable form of curcumin, and the results may not relate well to the effects of oral ingestion of turmeric itself.

In spite of these caveats, there is promising evidence that turmeric may be helpful for fighting infections and some cancers, reducing inflammation, and treating digestive problems.

The curcumin in turmeric has been shown to stimulate the production of bile by the gallbladder.

Curcumin is also a powerful antioxidant. Antioxidants protect the body from the adverse effects of very reactive molecules called free radicals, which damage cell membranes and DNA, and may even cause cell death.

In addition, curcumin reduces inflammation by lowering levels of two inflammatory enzymes (called COX-2 and LOX) in the body and stops platelets from clumping together to form blood clots. COX-2 is the target enzyme of the non-steroidal anti-inflammatory drugs, so curcumin works in a similar way to these drugs, without the side-effects.

Indigestion

At least one double-blind placebo-controlled study has shown that turmeric was effective for treating people with indigestion, reducing symptoms of bloating and gas. In Germany, turmeric has been approved for use in treating digestive disorders.

Ulcerative colitis

In one double-blind placebo-controlled study, people whose ulcerative colitis was in remission either received curcumin or placebo, along with conventional medical treatment for 6 months. Those who took curcumin had a relapse rate that was much lower than those who took the placebo.

Stomach ulcers

Turmeric does not appear to be helpful in treating stomach ulcers, and there is some evidence that it may increase the amount of acid in the stomach, making existing ulcers worse.

Osteoarthritis

Turmeric may be useful for relieving symptoms of osteoarthritis due to its ability to reduce inflammation. A study of people using an Ayurvedic formula of herbs and minerals containing turmeric as well as Withinia somnifera (winter cherry), Boswellia serrata and zinc significantly reduced pain and disability. Due to the study design, it is not possible to know if this effect is from turmeric alone, or the combination of herbs working together.

Atherosclerosis

In animal studies, an extract of turmeric lowered cholesterol levels and kept LDL or ‘bad’ cholesterol from building up in blood vessels, a process that can result in blocked arteries leading to heart attack or stroke. Turmeric also stops platelets from clumping together, so may help to prevent build-up of blood clots along the artery walls. These findings need to be confirmed in clinical trials.

Cancer

There is substantial interest in turmeric’s potential anti-cancer properties. Evidence from test tube and animal studies suggests that curcumin may help prevent, control or kill several types of cancer cells, including prostate, breast, skin and colon. Curcumin’s effects may be due to its ability to stop the blood vessels that supply cancerous tumours from growing, and from its effects as an antioxidant, protecting cells from damage. More research is needed in order to understand if turmeric is effective in preventing or treating cancer in humans.

Diabetes

When laboratory animals with diabetes were given turmeric, their blood sugar levels dropped, as did their cholesterol levels. Researchers do not yet know if such effects will occur in human subjects with diabetes.

Bacterial and viral infections

Anti-microbial properties of turmeric have been observed in laboratory studies but there is little data available on similar effects in humans.

Uveitis

In one study of 32 people with uveitis, inflammation of the eye, curcumin appeared to be as effective as corticosteroids.

If a teaspoon of turmeric is added to the cooking water of brown rice, the rice becomes a bright yellow colour. This yellow-coloured rice can then be used in dishes such as paella, kedgeree and rice salad, together with multi-coloured vegetables, such as red pepper, sauteed courgettes, diced carrots, peas and sweetcorn. Children love the bright colours and this is a good way to tempt them to eat more nourishing whole grains and vegetables.